Yusuf Syed Wamique, Iliescu Cezar, Bathina Jaya D, Daher Iyad N, Durand Jean-Bernard
Department of Cardiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
Tex Heart Inst J. 2010;37(3):336-40.
Platelets are crucial in the pathogenesis of acute coronary syndrome. Treatment for acute coronary syndrome usually involves antiplatelet, anticoagulant, and antithrombotic therapy, and the performance of percutaneous coronary intervention. All of the medications are associated with bleeding sequelae and are typically withheld from patients who have thrombocytopenia. The safety of antiplatelet therapy and percutaneous coronary intervention in patients who have acute coronary syndrome and thrombocytopenia is unknown, and there are no guidelines or randomized studies to suggest a treatment approach in such patients. Acute coronary syndrome is uncommon in patients who have thrombocytopenia; however, it occurs in up to 39% of patients who have both thrombocytopenia and cancer. Herein, we present the cases of 5 patients with acute coronary syndrome, thrombocytopenia, and cancer who underwent percutaneous coronary intervention with stenting. Before intervention, their platelet counts ranged from 17 to 72 x 10(9)/L. One patient underwent preprocedural platelet transfusion. All were given aspirin, alone or with clopidogrel. One patient experienced melena (of colonic origin). No other patient experienced bleeding sequelae. Aside from the occasional use of antiplatelet and thrombolytic agents in patients with thrombocytopenia, no therapeutic recommendation can be made until data are available on a larger patient population. Until then, treatment should conform to specific clinical circumstances. Approaches to the treatment of acute coronary syndrome in patients with thrombocytopenia might be better directed toward the evaluation of platelet function rather than toward absolute platelet count, and the risk-benefit equation of invasive procedures and antithrombotic therapies may need to incorporate this information.
血小板在急性冠脉综合征的发病机制中起关键作用。急性冠脉综合征的治疗通常包括抗血小板、抗凝和抗血栓治疗，以及进行经皮冠状动脉介入治疗。所有这些药物都与出血后遗症相关，通常不给血小板减少的患者使用。急性冠脉综合征合并血小板减少患者进行抗血小板治疗和经皮冠状动脉介入治疗的安全性尚不清楚，也没有指南或随机研究来指导此类患者的治疗方法。血小板减少患者中急性冠脉综合征并不常见；然而，在同时患有血小板减少症和癌症的患者中，其发生率高达39%。在此，我们报告5例急性冠脉综合征、血小板减少症和癌症患者接受经皮冠状动脉介入支架置入术的病例。干预前，他们的血小板计数范围为17至72×10⁹/L。1例患者在术前接受了血小板输注。所有患者均单独或联合使用氯吡格雷给予阿司匹林。1例患者出现黑便（源于结肠）。没有其他患者出现出血后遗症。除了偶尔对血小板减少患者使用抗血小板和溶栓药物外，在获得更多患者的数据之前无法给出治疗建议。在此之前，治疗应根据具体临床情况而定。血小板减少患者急性冠脉综合征的治疗方法可能更好地指向血小板功能评估而非绝对血小板计数，侵入性操作和抗血栓治疗的风险效益平衡可能需要纳入这一信息。
